_Remote, full-time | 8:00 AM - 4:00 PM EST_
- Salary: $1,200-1,400 USD/month_
- Experience with claims/billing in nursing homes required _

We are seeking an experienced Claims Specialist to manage insurance billing, follow-up, and revenue recovery for a Skilled Nursing Facility (SNF). This role is responsible for ensuring timely, accurate reimbursement from Medicare, Medicaid, and managed care payers by submitting clean claims, resolving denials, and aggressively following up on unpaid balances.

This is a results-driven AR role, not entry-level billing.

Claims Management
- Prepare, submit, and monitor Medicare, Medicaid, and managed care claims:
- Ensure claims comply with SNF-specific billing rules (PDPM, skilled days, benefit periods)
- Submit corrected claims as needed

Denials & Appeals
- Analyze claim denials and underpayments
- Identify root causes (authorization, eligibility, coding, timely filing, coverage)
- Prepare and submit appeals with supporting documentation:
- Track appeal deadlines and outcomes

AR Follow-Up




- Follow up on aged and unpaid claims via payer portals and phone calls
- Document all payer interactions clearly and accurately
- Escalate unresolved issues to supervisors when appropriate

Payment Posting & Reconciliation
- Review EOBs/ERAs for accuracy
- Identify short pays and request adjustments
- Reconcile payer balances against expected reimbursement

Cross-Functional Collaboration
- Work closely with billing, MDS, and clinical teams to resolve discrepancies
- Request and validate documentation needed to support claims and appeals

Compliance
- Maintain compliance with Medicare, Medicaid, and payer regulations
- Support audit requests and prevent recoupments through accurate billing

We need the following requirements:
- 2+ years of SNF or nursing home AR / claims experience (required):
- Strong knowledge of:
- Medicare Part A billing
- Medicaid billing processes
- Managed care authorizations
- PDPM reimbursement methodology
- Experien

📌 Biller/claims Specialist (Estado de México)
🏢 Remote Hive
📍 Estado de México